Quality of Care for Persons with
Disabilities
A Position Paper by the Institute on Public Policy
for Persons with Disabilities
Issue: In Illinois, the quality of care provided to
thousands of individuals with developmental
disabilities is in jeopardy due to a critical lack
of staff in private community service providers. The
Institute on Public Policy for People with
Disabilities believes that protection of the health,
safety and welfare of people with disabilities
requires direct care staff, qualified mental
retardation professionals and direct care program
management staff to receive reasonable, competitive
wages and benefits. The Governor and Illinois
Legislature needs to act now to address this
critical issue.
Discussion: The availability of a
well-trained, experienced and stable work force is
the most critical factor in assuring that quality
care and services are provided to individuals with
disabilities in the Illinois community based system
of services. Such is not the case in the Illinois
system today. Direct care staff turnover and a
shrinking workforce has created a service
environment that is struggling to maintain standards
and assure quality services. However, the realities
of the current service environment need to be
understood.
Direct Care Staff Turnover
In 1997 the volume of separations
from direct care positions in small community
residential settings was 43%. This same year, 8 out
of 10 new direct care staff hired left during their
first year of employment .
This means that close to half of the direct care
positions in any small residential setting needs to
be replaced each year. Even more disturbing is the
finding that 80% of the new direct care staff hired
in 1997 to fill vacancies, left during their first
year of employment. Some staff left after only three
months. The situation during 1999 has not improved;
if anything, the problem has increased.
High turnover results in
continuous direct care position vacancies across
residential settings, requiring available staff to
work unusual overtime hours. This causes staff
burnout and stress, leading to further employment
terminations. High turnover with 8 of 10 new direct
care staff leaving during the first year of
employment creates a staffing situation with few
experienced staff on duty. New direct care
employees, with limited training, are the core
"hands on" staff implementing program plans and
dealing with the individual service demands of those
served. In order to provide coverage, these
inexperienced employees are frequently called on to
work overtime.
The lack of a stable direct care
work force has a specific impact on the quality of
services proved to individuals with developmental
disabilities. High staff turnover works against
having a well trained direct care staff with
experience meeting the needs of the individuals in
each setting. It can be argued that there is a
relationship between the number of incidents of
abuse or neglect and an inexperienced direct care
workforce with limited training.
Quality of Care for Persons with
Disabilities
A Position Paper by the Institute on Public Policy
for Persons with Disabilities
Low Wages and a Shrinking
Workforce
Wages paid to direct care staff
serving individuals with developmental disabilities
in the community residential service system have
always been inadequate. However, during periods of
high unemployment, community service providers were
better able to recruit into direct care positions.
Today, with a robust economy and remarkably low
unemployment, community agencies are finding it
extremely difficult to recruit direct care staff due
to a shrinking workforce and non-competitive wages.
The state-wide average starting
wage for direct care staff in small community
residential settings in 1997 was $6.53 per hour.
Despite last year's targeted increase, direct care
staff still cannot be recruited into vacant
positions. The majority of staff hired still leave
within the first year of employment due to low
wages.
Recruitment of direct care staff
is not only made difficult by high employment; labor
market trends indicate that the number of positions
in the human service support category is expected to
increase dramatically over the next decade. However,
population projections for those most likely to fill
these jobs, indicate a decrease in the next five
years and beyond. If something is not done now to
address this problem, a bad situation will only
become much worse.
Wages need to be significantly
increased in order to make these jobs more
attractive career opportunities. Only then, will the
community service system be able to assure a stable,
experienced direct care workforce. Improved wages
will position community service providers to better
compete in the recruitment of direct care staff in
this time a shrinking labor market.
Recommendations and Outcomes
It is recommended that the
Governor and Illinois General Assembly identify this
issue as a priority that requires joint action. The
average hourly wages of direct care workers,
qualified mental retardation professionals and their
program management staffs need to be increased by
$2.10 an hour.
This increase will reduce direct
care staff turnover and allow community service
providers to build a better trained, experienced and
stable direct care workforce. This will help to
assure the availability of quality care in the
Illinois community service system for individuals
with developmental disabilities.
